CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

DIFFERENTIAL DIAGNOSIS IN ANAPHYLAXIS

Çağla Karavaizoğlu

Başakşehir Çam and Sakura City Hospital, Department of Pediatric Immunology and Allergic Diseases, İstanbul, Türkiye

Karavaizoğlu Ç. Differential Diagnosis in Anaphylaxis. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.239-247.

ABSTRACT

Anaphylaxis is a rapidly emerging, potentially fatal hypersensitivity reaction that may arise through multiple underlying pathways. It often develops in response to an identifiable trigger and manifests with various clinical signs and symptoms. Because several organ systems are typically involved, a wide differential diagnosis is necessary. Timely recognition and immediate treatment are crucial to prevent serious outcomes. In pediatric patients, vasovagal syncope frequently represents the closest clinical mimic. The overall pattern of symptom presentation, the trajectory of the clinical course, and the response to initial interventions offer valuable guidance in distinguishing anaphylaxis from other conditions. Differential diagnoses also include urticaria, angioedema, asthma flare-ups, and a range of cardiac, neuropsychiatric, endocrine, and gastrointestinal disorders. The most critical elements in differentiating these diagnoses are a comprehensive medical history and a thorough physical examination. While laboratory tests can be valuable as adjuncts in suspected cases, it is essential to remember that the diagnosis of anaphylaxis is primarily clinical.

Keywords: Anaphylaxis; Differential diagnosis; Hypersensitivity; Child

Referanslar

  1. Lee S, Bellolio MF, Hess EP, Campbell RL. Predictors of Biphasic Reactions in the Emergency Department for Patients With Anaphylaxis. J Allergy Clin Immunol Pract. 2014;2(3):281-287. [Crossref]  [PubMed]
  2. Yucel E, Sipahi Cimen S, Varol S, Suleyman A, Ozdemir C, Tamay ZU. Red meat desensitization in a child with delayed anaphylaxis due to alpha-Gal allergy. Pediatric Allergy and Immunology. 2019;30(7):771-773. [Crossref]  [PubMed]
  3. Abrams EM, Alqurashi W, Fischer DA, Vander Leek TK, Ellis AK. Anaphylaxis. Allergy Asthma Clin Immunol. 2024;20(Suppl 3):62. [Crossref]  [PubMed]  [PMC]
  4. Greenhawt M, Gupta R S, Meadows J A, Pistiner M, Spergel J M, Camargo C A, et al. Guiding Principles for the Recognition, Diagnosis, and Management of Infants with Anaphylaxis: An Expert Panel Consensus. The journal of allergy and clinical immunology. 2019;7(4):1148-1156. [Crossref]  [PubMed]
  5. Valent P, Sotlar K, Horny HP, Arock M, Akin C. World Health Organization Classification and Diagnosis of Mastocytosis: Immunol Allergy Clin North Am. 2023;43(4);627649. [Crossref]  [PubMed]
  6. Mateja A, Wang Q, Chovanec J, Kim J, Wilson KJ, Schwartz LB, et al. Defining baseline variability of serum tryptase levels improves accuracy in identifying anaphylaxis. Journal of Allergy and Clinical Immunology. 2022;149(3):1010-1017. [Crossref]  [PubMed]  [PMC]
  7. Mori F, Saretta F, Giovannini M, Gelsomino M, Liotti L, Barni S, et al. Pediatric idiopathic anaphylaxis: practical management from infants to adolescents. Ital J Pediatr. 2024;50(1):145. [Crossref]  [PubMed]  [PMC]
  8. Wang J, Lieberman JA, Wallace D V., Waserman S, Golden DBK. Anaphylaxis in Practice: A Guide to the 2023 Practice Parameter Update. J Allergy Clin Immunol Pract. 2024;12(9):2325-2336. [Crossref]  [PubMed]
  9. Orhan F, Cıvelek E, Şahıner ÜM, Arga M, Can D, Çalıkaner AZ, et al. Anaphylaxis: Turkish National Guideline 2018. Asthma Allergy Immunology 2018;16:16-18.
  10. Sekerel BE, Ilgun Gurel D, Sahiner UM, Soyer O, Kocaturk E. The many faces of pediatric urticaria. Front Allergy. 2023;4:1267663. [Crossref]  [PubMed]  [PMC]
  11. Farkas H, Martinez-Saguer I, Bork K, Bowen T, Craig T, Frank M, et al. International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency. Allergy. 2017;72(2):300-313. [Crossref]  [PubMed]  [PMC]
  12. Pagnier A, Dermesropian A, Kevorkian-Verguet C, Bourgoin-Heck M, Hoarau C, Reumaux H, et al. He reditary angioedema in children: Review and practical perspective for clinical management. Pediatr Allergy Immunol. 2024;35(12):e14268. [Crossref]  [PubMed]  [PMC]
  13. Alessandri C, Ferrara R, Bernardi ML, Zennaro D, Tuppo L, Giangrieco I, et al. Molecular approach to a patient's tailored diagnosis of the oral allergy syndrome. Clin Transl Allergy. 2020;10:22. [Crossref]  [PubMed]  [PMC]
  14. Sicherer SH, Warren CM, Dant C, Gupta RS, Nadeau KC. Food Allergy from Infancy Through Adulthood. J Allergy Clin Immunol Pract. 2020;8(6):1854-1864. [Crossref]  [PubMed]  [PMC]
  15. Lyons JJ, Yu X, Hughes JD, Le QT, Jamil A, Bai Y, et al. Elevated basal serum tryptase identifies a multisystem disorder associated with increased TPSAB1 copy number. Nat Genet. 2016;48(12):1564-1569. [Crossref]  [PubMed]  [PMC]
  16. Lyons JJ. Hereditary Alpha Tryptasemia. Immunol Allergy Clin North Am. 2018;38(3):483-95. [Crossref]  [PubMed]  [PMC]
  17. Carter MC, Desai A, Komarow HD, Bai Y, Clayton ST, Clark AS, et al. A distinct biomolecular profile identifies monoclonal mast cell disorders in patients with idiopathic anaphylaxis. Journal of Allergy and Clinical Immunology. 2018;141(1):180-188. [Crossref]  [PubMed]  [PMC]
  18. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020 Oct 30;13(10):100472. [Crossref]  [PubMed]  [PMC]
  19. Dosanjh A. Infant anaphylaxis: the importance of early recognition. J Asthma Allergy. 2013;6:103-107. [Crossref]  [PubMed]  [PMC]
  20. Sargant N, Erlewyn-Lajeunesse M, Benger J. Does anaphylaxis masquerade as asthma in children? Emergency Medicine Journal. 2015;32(1):83-84. [Crossref]  [PubMed]
  21. Muraro A, Worm M, Alviani C, Cardona V, DunnGalvin A, Garvey LH, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022;77(2):357-377. [Crossref]  [PubMed]
  22. Martelli A, Ghiglioni D, Sarratud T, Calcinai E, Veehof S, Terracciano L, et al. Anaphylaxis in the emergency department: a paediatric perspective. Curr Opin Allergy Clin Immunol. 2008;8(4):321-329. [Crossref]  [PubMed]
  23. Liao Y, Du J. Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update. Neurosci Bull. 2020;36(6):667-681 gov/17767437 Karavaizoğlu Differential Diagnosis in Anaphylaxis [Crossref]  [PubMed]  [PMC]
  24. Nowak-Węgrzyn A, Katz Y, Mehr SS, Koletzko S. Non- IgE-mediated gastrointestinal food allergy. Journal of Allergy and Clinical Immunology. 2015;135(5):1114-1124. [Crossref]  [PubMed]
  25. Anvari S, Ruffner MA, Nowak-Wegrzyn A. Current and future perspectives on the consensus guideline for food protein-induced enterocolitis syndrome (FPIES). Allergol Int. 2024;73(2):188-195. [Crossref]  [PubMed]
  26. İkizoğlu G. Red face revisited: Flushing. Clin Dermatol. 2014;32(6):800-808. [Crossref]  [PubMed]
  27. Lobo-Valbuena B, Martin-Gorgojo A, Zafra-Cobo I, Sánchez-Estella J. Safety in Dermatologic Procedures: Anaphylaxis, Vasovagal Reaction, and Hyperventilation. Actas dermo-sifiliograficas. 2021 Mar 19:S0001-70(21)00115-0.
  28. Mahmud R, Joy KMNI, Rassel MA, Monayem FB, Datta PK, Hossain MS, et al. Health hazards related to using masks and/or personal protective equipment among physicians working in public hospitals in Dhaka: A cross-sectional study. PLoS One. 2022;17(9):e0274169. [Crossref]  [PubMed]  [PMC]
  29. Patterson R, Schatz M. Factitious allergic emergencies: anaphylaxis and laryngeal "edema". J Allergy Clin Immunol. 1975;56(2):152-159. [Crossref]  [PubMed]
  30. Hsu P, Xie Z, Frith K, Wong M, Kakakios A, Stone KD, et al. Idiopathic Systemic Capillary Leak Syndrome in Children. Pediatrics. 2015;135(3):e730-735. [Crossref]  [PubMed]  [PMC]